Conventional medical clamps have serious disadvantages when used for securing and manipulating cartilage within a joint during arthroscopic surgery. Primarily, such clamps do not provide adequate fixation of the tissue during surgery, the clamps having a tendency to slip off the cartilage. Additionally, the size of the clamps in relation to the relatively small space inside the joint makes it difficult to maneuver other surgical tools such as the scalpel or arthroscope within the confined space of the joint. Such clamps can also interfere substantially with the view of the inside of the joint afforded by the arthroscope. Since such clamps must be introduced into the joint through an incision, they are consequently limited in their range of manipulation by the location of the introductory incision. In order to apply a desired directional traction to the cartilage, it may be necessary to release the cartilage, reintroduce the clamps through another incision, and reclamp the cartilage. Finally, the size of the instruments involved in an arthroscopic procedure makes the use of more than one instrument through a single incision undesirable, thereby necessitating multiple incisions.
It is often desirable to attach fibrous tissue such as a ligament or tendon to a bone, or to other fibrous tissue, to promote natural healing and reattachment of such tissue after it has been torn free from its normal point of attachment. While it has been possible through an arthroscopic procedure in some instances to insert two needles and then thread both of them to form a loop of thread to reattach fibrous tissue to similar fibrous tissue, that has been a long and involved process and is therefore somewhat undesirable. The alternative of more radical arthrotomy is also undesirable because of the increased amount of trauma and resultant increased morbidity encountered in the use of such a procedure.
As is explained in the following summary and detailed description, the present invention utilizes a tool for piercing cartilage and other fibrous tissue and anchoring a suture extending therethrough, the tool including a hollow needle and a tube which is slideable therein. Some technical references that may be of general interest with respect to devices for piercing tissue and with respect to devices involving one tubular member slidable within another are as follows: Allen U.S. Pat. No. 3,699,969; Shein U.S. Pat. No. 3,527,223; Woo U.S. Pat. No. 3,943,932; Almen U.S. Pat. No. 3,500,820; Johnson et al. U.S. Pat. No. 3,871,368; and Smith U.S. Pat. No. 4,243,037. However, none of these references discloses methods or apparatus suitable for holding and manipulating cartilage during arthroscopic surgery, nor for permanently retaining fibrous tissue attached to bone structure or other fibrous tissue.